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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 014700133
Report Date: 01/05/2022
Date Signed: 01/05/2022 10:28:00 AM

Document Has Been Signed on 01/05/2022 10:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:NESTVY HOME CAREFACILITY NUMBER:
014700133
ADMINISTRATOR:DOUGLAS, MATTHEWFACILITY TYPE:
300
ADDRESS:66 FRANKLIN ST SUITE 300TELEPHONE:
(800) 570-7874
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 0CENSUS: DATE:
01/05/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nicole ShihTIME COMPLETED:
11:00 AM
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Home Care Services Bureau (HCSB) analyst, Ramsey Chimienti arrived at the business office of Nestvy Home Care on 1/5/22. Upon arrival, the HCSB analyst identified himself and was greeted by Nicole Shih. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with Nicole and informed her that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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